College of Medicine and Public Health, Flinders Rural Health South Australia, Flinders University, Po Box 852, Ral Ral Avenue, Renmark, Australia.
BMC Psychiatry. 2021 Jan 13;21(1):36. doi: 10.1186/s12888-020-03033-w.
High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the 'Harmony in the Bush Dementia Study'. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention.
Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.
The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer's disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents' medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control.
Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data.
ANZCTR, ACTRN12618000263291 . Registered on 20th February 2018.
尽管精神类药物的疗效有限且存在相关副作用，但在养老院中仍大量开具此类药物。我们旨在评估“Harmony in the Bush 痴呆症研究”中患有痴呆症的老年居民的处方模式变化。“Harmony in the Bush”是一种基于逐渐降低应激阈值和以人为中心的音乐干预原则的养老院痴呆症护理模式。
我们的大型研究（为期 12 周）采用准实验设计，在澳大利亚的五家农村养老院进行。从三家农村养老院回顾性收集了 31 名患者的用药图表。每位患者的用药数据均来自三个月的用药图表，包括干预前和干预后。53 名员工在干预后以及 1 个月和 3 个月随访时参加了 31 次半结构式访谈和 8 次焦点小组。
参与者的中位年龄为 83 岁，其中 68%为女性。87%（n=27）的患者存在多种药物治疗。在居民中确定的主要合并症为高血压、高血脂、糖尿病和阿尔茨海默病。没有居民接受的精神类药物剂量超过指南推荐的最大剂量。与干预前和干预后 3 个月的患者用药图表数据相比，至少使用任何精神类药物的患者减少了 22.4%（77.4%比 55%），使用抗精神病药和苯二氮䓬类药物的患者减少了 19.6%（39%比 19.4%），使用抗抑郁药的患者减少了 6.5%（42%比 35.5%），但这些变化无统计学意义。此外，不适当药物的使用呈下降趋势。多达 43%的参与者和 44%的参与者持续使用抗精神病药物和抗痴呆药物超过 6 个月。从定性数据中提取出三个主题，包括由于药物逐渐减少或剂量减少而导致痴呆的行为和精神症状减轻、减少药物使用的其他策略以及环境或噪音控制。
我们的研究结果表明，Harmony in the Bush 模式作为一种非药物治疗方法，通过定量和定性数据的支持，减少了农村养老院中精神类药物的处方。
澳大利亚新西兰临床试验注册中心，ACTRN12618000263291。于 2018 年 2 月 20 日注册。
